{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T04:36:02Z","timestamp":1793075762369,"version":"4.5.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,10,19]],"date-time":"2020-10-19T00:00:00Z","timestamp":1603065600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,10,19]],"date-time":"2020-10-19T00:00:00Z","timestamp":1603065600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100001465","name":"American Thoracic Society","doi-asserted-by":"crossref","award":["ATS-2017-29"],"award-info":[{"award-number":["ATS-2017-29"]}],"id":[{"id":"10.13039\/100001465","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infect Dis Poverty"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>India reports the highest number of tuberculosis (TB) cases worldwide. Poverty has a dual impact as it increases the risk of TB and exposes the poor to economic hardship when they develop TB. Our objective was to estimate the costs incurred by patients with drug-susceptible TB in Bhavnagar (western India) using an adapted World Health Organization costing tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a descriptive cross-sectional study of adults, notified in the public sector and being treated for drug-susceptible pulmonary TB during January\u2013June 2019, in six urban and three rural blocks of Bhavnagar region, Gujarat state, India. The direct and indirect TB-related costs, as well as patients\u2019 coping strategies, were assessed for the overall care of TB till treatment completion. Catastrophic costs were defined as total costs &gt;\u200920% of annual household income (excluding any amount received from cash transfer programs or borrowed). Median and interquartile range (IQR) was used to summarize patient costs. The median costs between any two groups were compared using the median test. The association between any two categorical variables was tested by the Pearson chi-squared test. All costs were described in US dollars (USD). During the study period, on average, one USD equalled 70 Indian Rupees.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 458 patients included, 70% were male, 62% had no formal education, 71% lived in urban areas, and 96% completed TB treatment. The median (IQR) total costs were USD 8 (5\u201328), direct medical costs were USD 0 (0\u20130), direct non-medical costs were USD 3 (2\u20134) and indirect costs were USD 6 (3\u201313). Among direct non-medical costs, travel cost (median\u2009=\u2009USD 3, IQR: 2\u20134) to attend health facilities were the most prominent, whereas the indirect costs were mainly contributed by the patient\u2019s loss of wages (median\u2009=\u2009USD 3, IQR: 0\u20136). Four percent of patients faced catastrophic costs, 11% borrowed money to cover costs and 7% lost their employment; the median working days lost to TB was 30 (IQR: 15\u201345). A majority (88%) of patients received a median USD 43 (IQR: 41\u201343) as part of a cash transfer program for TB patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Treatment completion was high and the costs incurred by TB patients were low in this setting. However, negative financial consequences occur even in low-cost settings. The role of universal cash transfer programs in such settings requires further study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40249-020-00760-w","type":"journal-article","created":{"date-parts":[[2020,10,19]],"date-time":"2020-10-19T09:04:25Z","timestamp":1603098265000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Costs incurred by patients with drug-susceptible pulmonary tuberculosis in semi-urban and rural settings of Western India"],"prefix":"10.1186","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2174-1345","authenticated-orcid":false,"given":"Mihir P.","family":"Rupani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adithya","family":"Cattamanchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priya B.","family":"Shete","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William M.","family":"Vollmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjib","family":"Basu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jigna D.","family":"Dave","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,10,19]]},"reference":[{"key":"760_CR1","volume-title":"Global Tuberculosis Report 2019","author":"World Health Organization","year":"2019","unstructured":"World Health Organization. Global Tuberculosis Report 2019. Geneva: WHO Press; 2019."},{"key":"760_CR2","volume-title":"Tuberculosis patient cost surveys: a handbook","author":"World Health Organization","year":"2017","unstructured":"World Health Organization. Tuberculosis patient cost surveys: a handbook. Geneva: WHO Press; 2017."},{"key":"760_CR3","volume-title":"The end TB strategy","author":"World Health Organization","year":"2015","unstructured":"World Health Organization. The end TB strategy. Geneva: WHO Press; 2015."},{"key":"760_CR4","volume-title":"Global Tuberculosis Report 2018","author":"World Health Organization","year":"2018","unstructured":"World Health Organization. Global Tuberculosis Report 2018. Geneva: WHO Press; 2018."},{"issue":"2","key":"760_CR5","doi-asserted-by":"publisher","first-page":"94","DOI":"10.3390\/tropicalmed4020094","volume":"4","author":"K Viney","year":"2019","unstructured":"Viney K, Islam T, Hoa NB, Morishita F, L\u00f6nnroth K. The financial burden of tuberculosis for patients in the Western-Pacific region. Trop Med Infect Dis. 2019;4(2):94.","journal-title":"Trop Med Infect Dis"},{"key":"760_CR6","doi-asserted-by":"publisher","first-page":"983","DOI":"10.5588\/ijtld.17.0859","volume":"22","author":"NV Nhung","year":"2018","unstructured":"Nhung NV, Hoa NB, Anh NT, Anh LTN, Siroka A, L\u00f6nnroth K, et al. Measuring catastrophic costs due to tuberculosis in Viet Nam. Int J Tuberc Lung Dis. 2018;22:983\u201390.","journal-title":"Int J Tuberc Lung Dis."},{"key":"760_CR7","unstructured":"Ministry of Health (Uganda). Direct and indirect costs due to tuberculosis and proportion of tuberculosis-affected households experiencing catastrophic costs due to TB in Uganda. Uganda: Ministry of Health; 2019."},{"key":"760_CR8","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001675","volume":"11","author":"T Wingfield","year":"2014","unstructured":"Wingfield T, Boccia D, Tovar M, Gavino A, Zevallos K, Montoya R, et al. Defining catastrophic costs and comparing their importance for adverse tuberculosis outcome with multi-drug resistance: a prospective cohort study, Peru. PLoS Med. 2014;11:e1001675.","journal-title":"PLoS Med"},{"key":"760_CR9","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/j.ijtb.2018.10.009","volume":"66","author":"R Sarin","year":"2019","unstructured":"Sarin R, Vohra V, Singla N, Thomas B, Krishnan R, Muniyandi M. Identifying costs contributing to catastrophic expenditure among TB patients registered under RNTCP in Delhi metro city in India. Indian J Tuberc. 2019;66:150\u20137.","journal-title":"Indian J Tuberc"},{"key":"760_CR10","doi-asserted-by":"publisher","first-page":"1477493","DOI":"10.1080\/16549716.2018.1477493","volume":"11","author":"T Prasanna","year":"2018","unstructured":"Prasanna T, Jeyashree K, Chinnakali P, Bahurupi Y, Vasudevan K, Das M. Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India. Glob Health Action. 2018;11:1477493.","journal-title":"Glob Health Action"},{"issue":"7","key":"760_CR11","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1111\/tmi.13402","volume":"25","author":"A Chandra","year":"2020","unstructured":"Chandra A, Kumar R, Kant S, Parthasarathy R, Krishnan A. Direct and indirect patient costs of tuberculosis care in India. Tropical Med Int Health. 2020;25(7):803\u201312.","journal-title":"Tropical Med Int Health"},{"key":"760_CR12","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.20973","volume":"3","author":"M Muniyandi","year":"2020","unstructured":"Muniyandi M, Thomas BE, Karikalan N, Kannan T, Rajendran K, Saravanan B, et al. Association of tuberculosis with household catastrophic expenditure in South India. JAMA Netw Open. 2020;3:e1920973.","journal-title":"JAMA Netw Open"},{"issue":"3","key":"760_CR13","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1093\/trstmh\/trz127","volume":"114","author":"M Muniyandi","year":"2020","unstructured":"Muniyandi M, Thomas BE, Karikalan N, Kannan T, Rajendran K, Dolla CK, et al. Catastrophic costs due to tuberculosis in South India : comparison between active and passive case finding. Trans R Soc Trop Med Hyg. 2020;114(3):185\u201392.","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"760_CR14","first-page":"188","volume":"52","author":"M Muniyandi","year":"2005","unstructured":"Muniyandi M, Rajeswari R, Rani B. Costs to patients with tuberculosis treated under DOTS programme. Indian J Tuberc. 2005;52:188\u201396.","journal-title":"Indian J Tuberc"},{"key":"760_CR15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.21767\/2471-8521.100009","volume":"2","author":"M Muniyandi","year":"2016","unstructured":"Muniyandi M, Rao V, Bhat J, Yadav R, Sharma R. Household catastrophic health expenditure due to tuberculosis: analysis from particularly vulnerable tribal group, Central India. Med Mycol Open Access. 2016;2:1\u20139.","journal-title":"Med Mycol Open Access"},{"key":"760_CR16","first-page":"93","volume":"37","author":"TK Ray","year":"2005","unstructured":"Ray TK, Sharma N, Singh MM, Ingle GK. Economic burden of tuberculosis in patients attending DOT centres in Delhi. J Commun Dis. 2005;37:93\u20138.","journal-title":"J Commun Dis"},{"key":"760_CR17","first-page":"1281","volume":"13","author":"KR John","year":"2009","unstructured":"John KR, Daley P, Kincler N, Oxlade O, Menzies D. Costs incurred by patients with pulmonary tuberculosis in rural India. Int J Tuberc Lung Dis. 2009;13:1281\u20137.","journal-title":"Int J Tuberc Lung Dis"},{"key":"760_CR18","volume-title":"Government of India. Nutritional Support to TB patients (Nikshay Poshan Yojana)","author":"Central TB Division","year":"2018","unstructured":"Central TB Division. Government of India. Nutritional Support to TB patients (Nikshay Poshan Yojana). New Delhi: Ministry of Health & Family Welfare, Government of India; 2018."},{"key":"760_CR19","volume-title":"National Family Health Survey (NFHS-2) 1998\u201399. Mumbai, India","author":"International Institute for Population Sciences","year":"2000","unstructured":"International Institute for Population Sciences. National Family Health Survey (NFHS-2) 1998\u201399. Mumbai, India; 2000."},{"key":"760_CR20","first-page":"1042","volume":"11","author":"M Muniyandi","year":"2007","unstructured":"Muniyandi M, Ramachandran R, Gopi PG, Chandrasekaran V, Subramani R, Sadacharam K, et al. The prevalence of tuberculosis in different economic strata: a community survey from South India. Int J Tuberc Lung Dis. 2007;11:1042\u20135.","journal-title":"Int J Tuberc Lung Dis."},{"key":"760_CR21","volume-title":"Government of India. Revised National TB Control Programme: Technical and Operational Guidelines for Tuberculosis Control in India","author":"Central TB Division","year":"2016","unstructured":"Central TB Division. Government of India. Revised National TB Control Programme: Technical and Operational Guidelines for Tuberculosis Control in India. New Delhi: Ministry of Health and Family Welfare, Government of India; 2016."},{"key":"760_CR22","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.ijtb.2018.04.011","volume":"66","author":"JB Mullerpattan","year":"2019","unstructured":"Mullerpattan JB, Udwadia ZZ, Banka RA, Ganatra SR, Udwadia ZF. Catastrophic costs of treating drug resistant TB patients in a tertiary care hospital in India. Indian J Tuberc. 2019;66:87\u201391.","journal-title":"Indian J Tuberc"},{"key":"760_CR23","doi-asserted-by":"publisher","first-page":"2016","DOI":"10.3201\/eid2605.181992","volume":"26","author":"P Rathi","year":"2020","unstructured":"Rathi P, Shringapure K, Unnikrishnan B, Chadha VK, Acharya V, Nair A, et al. Pretreatment out-of-pocket expenses for presumptive multidrug-resistant tuberculosis patients, India, 2016\u20132017. Emerg Infect Dis. 2020;26:2016\u20137.","journal-title":"Emerg Infect Dis"},{"key":"760_CR24","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.socscimed.2018.08.041","volume":"215","author":"S Sweeney","year":"2018","unstructured":"Sweeney S, Mukora R, Candfield S, Guinness L, Grant AD, Vassall A. Measuring income for catastrophic cost estimates: limitations and policy implications of current approaches. Soc Sci Med. 2018;215:7\u201315.","journal-title":"Soc Sci Med"},{"key":"760_CR25","first-page":"1316","volume":"14","author":"VA Rouzier","year":"2010","unstructured":"Rouzier VA, Oxlade O, Verduga R, Gresely L, Menzies D. Patient and family costs associated with tuberculosis, including multidrug-resistant tuberculosis, in Ecuador. Int J Tuberc Lung Dis. 2010;14:1316\u201322.","journal-title":"Int J Tuberc Lung Dis"},{"key":"760_CR26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/journal.pone.0135802","volume":"10","author":"RD Deshmukh","year":"2015","unstructured":"Deshmukh RD, Dhande DJ, Sachdeva KS, Sreenivas A, Kumar AMV, Satyanarayana S, et al. Patient and provider reported reasons for lost to follow up in MDRTB treatment: a qualitative study from a drug resistant TB Centre in India. PLoS One. 2015;10:1\u201311.","journal-title":"PLoS One"},{"key":"760_CR27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-015-1138-z","volume":"15","author":"J Madan","year":"2015","unstructured":"Madan J, L\u00f6nnroth K, Laokri S, Squire SB. What can dissaving tell us about catastrophic costs? Linear and logistic regression analysis of the relationship between patient costs and financial coping strategies adopted by tuberculosis patients in Bangladesh, Tanzania and Bangalore, India. BMC Health Serv Res. 2015;15:1\u20138.","journal-title":"BMC Health Serv Res"},{"key":"760_CR28","doi-asserted-by":"publisher","first-page":"1396","DOI":"10.1183\/13993003.00066-2016","volume":"48","author":"T Wingfield","year":"2016","unstructured":"Wingfield T, Tovar MA, Huff D, Boccia D, Montoya R, Ramos E, et al. The economic effects of supporting tuberculosis-affected households in Peru. Eur Respir J. 2016;48:1396\u2013410.","journal-title":"Eur Respir J"},{"key":"760_CR29","doi-asserted-by":"publisher","first-page":"69","DOI":"10.4103\/2224-3151.206624","volume":"4","author":"D Kundu","year":"2015","unstructured":"Kundu D, Katre V, Singh K, Deshpande M, Nayak P, Khaparde K, et al. Innovative social protection mechanism for alleviating catastrophic expenses on multidrug-resistant tuberculosis patients in Chhattisgarh , India. WHO South-East Asia J Public Heal. 2015;4:69\u201377.","journal-title":"WHO South-East Asia J Public Heal"},{"key":"760_CR30","doi-asserted-by":"publisher","first-page":"1500","DOI":"10.1016\/j.ijsu.2014.07.014","volume":"12","author":"JP Vandenbroucke","year":"2014","unstructured":"Vandenbroucke JP, von Elm E, Altman DG, G\u00f8tzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. Int J Surg. 2014;12:1500\u201324.","journal-title":"Int J Surg"}],"container-title":["Infectious Diseases of Poverty"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40249-020-00760-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40249-020-00760-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40249-020-00760-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,18]],"date-time":"2021-10-18T20:42:59Z","timestamp":1634589779000},"score":1,"resource":{"primary":{"URL":"https:\/\/idpjournal.biomedcentral.com\/articles\/10.1186\/s40249-020-00760-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,19]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["760"],"URL":"https:\/\/doi.org\/10.1186\/s40249-020-00760-w","relation":{},"ISSN":["2049-9957"],"issn-type":[{"value":"2049-9957","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,19]]},"assertion":[{"value":"3 August 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 September 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 October 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study was approved by the Ethics Committee of the Government Medical College Bhavnagar (No. IRB-HEC\/772\/2018, dated 20-03-2018) and the Health Ministry Screening Committee of the Indian Council of Medical Research (ICMR). Written informed consent was taken from study participants before the interview.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"144"}}